TPress
1.
Ernst, M.; Altenburg, B.; Schmalz, T.; Kannenberg, A.; Bellmann, M.
Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes Artikel
In: J. NeuroEng. Rehabil., Bd. 19, Nr. 1, 2022, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking
@article{Ernst2022,
title = {Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes},
author = {M. Ernst and B. Altenburg and T. Schmalz and A. Kannenberg and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2014862458&from=export},
doi = {10.1186/s12984-022-00983-y},
issn = {1743-0003},
year = {2022},
date = {2022-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {19},
number = {1},
address = {M. Ernst, Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany},
abstract = {Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.},
keywords = {adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking},
pubstate = {published},
tppubtype = {article}
}
Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.
2.
Pröbsting, E.; Altenburg, B.; Bellmann, M.; Krug, K.; Schmalz, T.
In: Prosthet. Orthot. Int., Bd. 46, Nr. 4, S. 306–313, 2022, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adduction, adult, amputation, ankle, article, C Leg 4, camera, carbon fiber, clinical article, foot prosthesis, forefoot, human, knee, knee function, lower limb, male, microprocessor, retrospective study, sensor, walking, walking speed
@article{Proebsting2022,
title = {How does ankle power on the prosthetic side influence loading parameters on the sound side during level walking of persons with transfemoral amputation?},
author = {E. Pröbsting and B. Altenburg and M. Bellmann and K. Krug and T. Schmalz},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2019708323&from=export},
doi = {10.1097/pxr.0000000000000099},
issn = {0309-3646},
year = {2022},
date = {2022-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {46},
number = {4},
pages = {306–313},
address = {E. Pröbsting, Ottobock SE & Co. KGaA, Herrmann-Rein-Straße 2a, Göttingen, Germany},
abstract = {Background:Increased ankle power on the prosthetic side seems to decrease biomechanical loading parameters on the sound side. This assumption is based on biomechanical comparisons of different foot constructions. However, such study designs could not show whether the amount of ankle power solely influences the sound side.Objective:To analyze the influence of divergent ankle power, resulting from different foot constructions and from different ankle power settings, on the sound side loading parameters.Study design:Interventional cross sectional study.Methods:Level walking of transfemoral amputees with a microprocessor knee joint and Solid Ankle Cushioned Heel (SACH), energy storing and returning (ESR) and powered foot (PF) was analyzed. The PF was adapted in three configurations: without power (np), low power (lp), and optimal power (op). An optoelectronic camera system with 12 cameras and two force plates were used.Results:The ankle power on the prosthetic side shows significant differences about foot types and different settings of the PF. The knee adduction moment, the knee flexion moment, and the vertical ground reaction forces on the sound side were significantly reduced with PF_op and ESR in comparison to SACH. When analyzing these parameters for the different PF configurations, only some show significant results at normal velocity.Conclusions:The additional positive mechanical work for an active push off in the PF tends to have a relieving effect. The biomechanical sound side loading parameters are reduced with PF_op in comparison to SACH and ESR, resulting in a relief of the sound side of lower limb amputees.},
keywords = {adduction, adult, amputation, ankle, article, C Leg 4, camera, carbon fiber, clinical article, foot prosthesis, forefoot, human, knee, knee function, lower limb, male, microprocessor, retrospective study, sensor, walking, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background:Increased ankle power on the prosthetic side seems to decrease biomechanical loading parameters on the sound side. This assumption is based on biomechanical comparisons of different foot constructions. However, such study designs could not show whether the amount of ankle power solely influences the sound side.Objective:To analyze the influence of divergent ankle power, resulting from different foot constructions and from different ankle power settings, on the sound side loading parameters.Study design:Interventional cross sectional study.Methods:Level walking of transfemoral amputees with a microprocessor knee joint and Solid Ankle Cushioned Heel (SACH), energy storing and returning (ESR) and powered foot (PF) was analyzed. The PF was adapted in three configurations: without power (np), low power (lp), and optimal power (op). An optoelectronic camera system with 12 cameras and two force plates were used.Results:The ankle power on the prosthetic side shows significant differences about foot types and different settings of the PF. The knee adduction moment, the knee flexion moment, and the vertical ground reaction forces on the sound side were significantly reduced with PF_op and ESR in comparison to SACH. When analyzing these parameters for the different PF configurations, only some show significant results at normal velocity.Conclusions:The additional positive mechanical work for an active push off in the PF tends to have a relieving effect. The biomechanical sound side loading parameters are reduced with PF_op in comparison to SACH and ESR, resulting in a relief of the sound side of lower limb amputees.
3.
Köhler, T. M.; Blumentritt, S.; Braatz, F.; Bellmann, M.
In: Gait Posture, Bd. 89, S. 169–177, 2021, ISSN: 0966-6362.
Abstract | Links | Schlagwörter: above knee amputation, adduction, adult, article, biomechanics, camera, clinical article, controlled study, female, femoral knee prosthesis, gait, Genium, ground reaction force, human, male, microprocessor, motion analysis system, pelvis, prosthetic alignment, step length, transfemoral amputation, transfemoral prosthetic socket, Triton, trunk, tyloxapol, Vicon Bonita, walking, walking speed
@article{Koehler2021,
title = {The impact of transfemoral socket adduction on pelvic and trunk stabilization during level walking - A biomechanical study},
author = {T. M. Köhler and S. Blumentritt and F. Braatz and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2013710687&from=export},
doi = {10.1016/j.gaitpost.2021.06.024},
issn = {0966-6362},
year = {2021},
date = {2021-09-01},
journal = {Gait Posture},
volume = {89},
pages = {169–177},
publisher = {Elsevier BV},
address = {T.M. Köhler, Ottobock SE & Co. KGaA, Hermann-Rein-Straße 2a, Göttingen, Germany},
abstract = {Background: It is common practice to align transfemoral prosthetic sockets in adduction, due to the physiologic, adducted femoral alignment in unimpaired legs. An adducted femoral and socket alignment helps tightening hip abductors to stabilize the pelvis and reduce pelvic and trunk related compensatory movements. Research question: How do different socket adduction conditions (SAC) of transfemoral sockets affect pelvic and trunk stabilization during level ground walking in the frontal plane? Methods: Seven persons with transfemoral amputation with medium residual limb length participated in this study. The prosthetic alignment in the sagittal plane was performed according to established recommendations. SAC varied (0°, 3°, 6°, 9°). Kinematic and kinetic parameters were recorded in a gait laboratory with a 12-camera optoelectronic system and two piezoelectric force plates embedded in a 12-m walkway. The measurements were performed during level ground walking with self-selected comfortable gait speed. Results: In the frontal plane, nearly all investigated kinematic and kinetic parameters showed a strong correlation with the SAC. The pelvis was raised on the contralateral side throughout the gait cycle with increasing SAC. During the prosthetic side stance phase, the mean shoulder obliquity and mean lateral trunk lean to the prosthetic side tended to be reduced with increased SAC. Prosthetic side hip abduction moment decreased with increasing SAC. Significance: The results confirm that transfemoral SAC contributes to pelvic stabilization and reduced compensatory movements of the pelvis and trunk. Transfemoral SAC of 6 ± 1° for bench alignment seems adequate for amputees with medium residual limb length. However, the optimum value for the individual patient may differ slightly.},
keywords = {above knee amputation, adduction, adult, article, biomechanics, camera, clinical article, controlled study, female, femoral knee prosthesis, gait, Genium, ground reaction force, human, male, microprocessor, motion analysis system, pelvis, prosthetic alignment, step length, transfemoral amputation, transfemoral prosthetic socket, Triton, trunk, tyloxapol, Vicon Bonita, walking, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: It is common practice to align transfemoral prosthetic sockets in adduction, due to the physiologic, adducted femoral alignment in unimpaired legs. An adducted femoral and socket alignment helps tightening hip abductors to stabilize the pelvis and reduce pelvic and trunk related compensatory movements. Research question: How do different socket adduction conditions (SAC) of transfemoral sockets affect pelvic and trunk stabilization during level ground walking in the frontal plane? Methods: Seven persons with transfemoral amputation with medium residual limb length participated in this study. The prosthetic alignment in the sagittal plane was performed according to established recommendations. SAC varied (0°, 3°, 6°, 9°). Kinematic and kinetic parameters were recorded in a gait laboratory with a 12-camera optoelectronic system and two piezoelectric force plates embedded in a 12-m walkway. The measurements were performed during level ground walking with self-selected comfortable gait speed. Results: In the frontal plane, nearly all investigated kinematic and kinetic parameters showed a strong correlation with the SAC. The pelvis was raised on the contralateral side throughout the gait cycle with increasing SAC. During the prosthetic side stance phase, the mean shoulder obliquity and mean lateral trunk lean to the prosthetic side tended to be reduced with increased SAC. Prosthetic side hip abduction moment decreased with increasing SAC. Significance: The results confirm that transfemoral SAC contributes to pelvic stabilization and reduced compensatory movements of the pelvis and trunk. Transfemoral SAC of 6 ± 1° for bench alignment seems adequate for amputees with medium residual limb length. However, the optimum value for the individual patient may differ slightly.
4.
Yazdani, M.; Hajiaghaei, B.; Saeedi, H.; Kamali, M.; Yousefi, M.
In: Curr. Orthop. Pract., Bd. 32, Nr. 5, S. 505–511, 2021, ISSN: 1940-7041.
Abstract | Links | Schlagwörter: adult, amputee, article, camera, case study, clinical article, comparative study, compression release stabilization, data analysis software, evaluation study, female, femoral shaft, foot prosthesis, gait, gluteus muscle, human, information processing device, IRCT20181021041400N1, ischial tuberosity, kinematics, knee prosthesis, leather belt wrap, limb amputation, male, MATLAB, medical device, middle aged, motion analysis system, orthopedic cast, orthopedic surgical equipment, Ottobock 3R20, pilot study, prosthesis design, quadrilateral socket, solid ankle cushioned heel foot, statistical model, step length, step time, step width, stride length, stride time, symmetry index, transfemoral socket, walking, walking speed, weight training, Wilcoxon signed ranks test
@article{Yazdani2021,
title = {Does the socket design affect symmetry and spatiotemporal gait parameters? A case series of two transfemoral amputees},
author = {M. Yazdani and B. Hajiaghaei and H. Saeedi and M. Kamali and M. Yousefi},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L635549609&from=export},
doi = {10.1097/bco.0000000000001022},
issn = {1940-7041},
year = {2021},
date = {2021-01-01},
journal = {Curr. Orthop. Pract.},
volume = {32},
number = {5},
pages = {505–511},
address = {B. Hajiaghaei, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Nezam Ave, Tehran, Iran},
abstract = {Background: Socket design is thought to improve gait performance and symmetry as the other components of the prosthesis do. This study focused on the comparison of two different sockets in transfemoral amputee patients to evaluate the influence of the socket designs on gait symmetry and various spatiotemporal gait parameters. Methods: Two transfemoral amputees participated in this case series study. They were asked to walk with the quadrilateral and the new modified sockets along a 10-meter walkway. The marker-based motion capture system recorded the spatiotemporal gait data during all walking trials. Kinematic data were compared between the two test conditions using the Wilcoxon signed-rank test and Symmetry Index. Results: The new socket increased velocity and cadence and reduced step width in both amputees, compared with the quadrilateral sockets. However, a good symmetry was observed in step length, stride length, step time, and stride time within two limbs by both sockets (SI ≤10). Conclusions: The design of sockets in this study had no observed effect on gait symmetry; however, the new socket increased velocity and cadence and reduced width step in both patients compared with the quadrilateral socket. Level of Evidence: Level IV.},
keywords = {adult, amputee, article, camera, case study, clinical article, comparative study, compression release stabilization, data analysis software, evaluation study, female, femoral shaft, foot prosthesis, gait, gluteus muscle, human, information processing device, IRCT20181021041400N1, ischial tuberosity, kinematics, knee prosthesis, leather belt wrap, limb amputation, male, MATLAB, medical device, middle aged, motion analysis system, orthopedic cast, orthopedic surgical equipment, Ottobock 3R20, pilot study, prosthesis design, quadrilateral socket, solid ankle cushioned heel foot, statistical model, step length, step time, step width, stride length, stride time, symmetry index, transfemoral socket, walking, walking speed, weight training, Wilcoxon signed ranks test},
pubstate = {published},
tppubtype = {article}
}
Background: Socket design is thought to improve gait performance and symmetry as the other components of the prosthesis do. This study focused on the comparison of two different sockets in transfemoral amputee patients to evaluate the influence of the socket designs on gait symmetry and various spatiotemporal gait parameters. Methods: Two transfemoral amputees participated in this case series study. They were asked to walk with the quadrilateral and the new modified sockets along a 10-meter walkway. The marker-based motion capture system recorded the spatiotemporal gait data during all walking trials. Kinematic data were compared between the two test conditions using the Wilcoxon signed-rank test and Symmetry Index. Results: The new socket increased velocity and cadence and reduced step width in both amputees, compared with the quadrilateral sockets. However, a good symmetry was observed in step length, stride length, step time, and stride time within two limbs by both sockets (SI ≤10). Conclusions: The design of sockets in this study had no observed effect on gait symmetry; however, the new socket increased velocity and cadence and reduced width step in both patients compared with the quadrilateral socket. Level of Evidence: Level IV.
5.
Shimizu, Y.; Mutsuzaki, H.; Maezawa, T.; Idei, Y.; Takao, K.; Takeuchi, R.; Onishi, S.; Hada, Y.; Yamazaki, M.; Wadano, Y.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 5, S. 522–526, 2017, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing
@article{Shimizu2017,
title = {Hip prosthesis in sitting posture for bilateral transfemoral amputee after burn injury: a case report},
author = {Y. Shimizu and H. Mutsuzaki and T. Maezawa and Y. Idei and K. Takao and R. Takeuchi and S. Onishi and Y. Hada and M. Yamazaki and Y. Wadano},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L618507994&from=export},
doi = {10.1177/0309364616682384},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {5},
pages = {522–526},
address = {Y. Shimizu, Department of Rehabilitation Medicine, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, Japan},
abstract = {Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.},
keywords = {adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing},
pubstate = {published},
tppubtype = {article}
}
Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.
2022
Ernst, M.; Altenburg, B.; Schmalz, T.; Kannenberg, A.; Bellmann, M.
Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes Artikel
In: J. NeuroEng. Rehabil., Bd. 19, Nr. 1, 2022, ISSN: 1743-0003.
Abstract | Links | Schlagwörter: adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking
@article{Ernst2022,
title = {Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes},
author = {M. Ernst and B. Altenburg and T. Schmalz and A. Kannenberg and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2014862458&from=export},
doi = {10.1186/s12984-022-00983-y},
issn = {1743-0003},
year = {2022},
date = {2022-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {19},
number = {1},
address = {M. Ernst, Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany},
abstract = {Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.},
keywords = {adult, aged, article, biomechanics, clinical article, controlled study, effect size, foot prosthesis, human, kinematics, knee function, leg amputation, microprocessor, middle aged, motion analysis system, patient participation, range of motion, slope factor, transfemoral amputation, transtibial amputation, walking},
pubstate = {published},
tppubtype = {article}
}
Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.
Pröbsting, E.; Altenburg, B.; Bellmann, M.; Krug, K.; Schmalz, T.
In: Prosthet. Orthot. Int., Bd. 46, Nr. 4, S. 306–313, 2022, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adduction, adult, amputation, ankle, article, C Leg 4, camera, carbon fiber, clinical article, foot prosthesis, forefoot, human, knee, knee function, lower limb, male, microprocessor, retrospective study, sensor, walking, walking speed
@article{Proebsting2022,
title = {How does ankle power on the prosthetic side influence loading parameters on the sound side during level walking of persons with transfemoral amputation?},
author = {E. Pröbsting and B. Altenburg and M. Bellmann and K. Krug and T. Schmalz},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2019708323&from=export},
doi = {10.1097/pxr.0000000000000099},
issn = {0309-3646},
year = {2022},
date = {2022-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {46},
number = {4},
pages = {306–313},
address = {E. Pröbsting, Ottobock SE & Co. KGaA, Herrmann-Rein-Straße 2a, Göttingen, Germany},
abstract = {Background:Increased ankle power on the prosthetic side seems to decrease biomechanical loading parameters on the sound side. This assumption is based on biomechanical comparisons of different foot constructions. However, such study designs could not show whether the amount of ankle power solely influences the sound side.Objective:To analyze the influence of divergent ankle power, resulting from different foot constructions and from different ankle power settings, on the sound side loading parameters.Study design:Interventional cross sectional study.Methods:Level walking of transfemoral amputees with a microprocessor knee joint and Solid Ankle Cushioned Heel (SACH), energy storing and returning (ESR) and powered foot (PF) was analyzed. The PF was adapted in three configurations: without power (np), low power (lp), and optimal power (op). An optoelectronic camera system with 12 cameras and two force plates were used.Results:The ankle power on the prosthetic side shows significant differences about foot types and different settings of the PF. The knee adduction moment, the knee flexion moment, and the vertical ground reaction forces on the sound side were significantly reduced with PF_op and ESR in comparison to SACH. When analyzing these parameters for the different PF configurations, only some show significant results at normal velocity.Conclusions:The additional positive mechanical work for an active push off in the PF tends to have a relieving effect. The biomechanical sound side loading parameters are reduced with PF_op in comparison to SACH and ESR, resulting in a relief of the sound side of lower limb amputees.},
keywords = {adduction, adult, amputation, ankle, article, C Leg 4, camera, carbon fiber, clinical article, foot prosthesis, forefoot, human, knee, knee function, lower limb, male, microprocessor, retrospective study, sensor, walking, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background:Increased ankle power on the prosthetic side seems to decrease biomechanical loading parameters on the sound side. This assumption is based on biomechanical comparisons of different foot constructions. However, such study designs could not show whether the amount of ankle power solely influences the sound side.Objective:To analyze the influence of divergent ankle power, resulting from different foot constructions and from different ankle power settings, on the sound side loading parameters.Study design:Interventional cross sectional study.Methods:Level walking of transfemoral amputees with a microprocessor knee joint and Solid Ankle Cushioned Heel (SACH), energy storing and returning (ESR) and powered foot (PF) was analyzed. The PF was adapted in three configurations: without power (np), low power (lp), and optimal power (op). An optoelectronic camera system with 12 cameras and two force plates were used.Results:The ankle power on the prosthetic side shows significant differences about foot types and different settings of the PF. The knee adduction moment, the knee flexion moment, and the vertical ground reaction forces on the sound side were significantly reduced with PF_op and ESR in comparison to SACH. When analyzing these parameters for the different PF configurations, only some show significant results at normal velocity.Conclusions:The additional positive mechanical work for an active push off in the PF tends to have a relieving effect. The biomechanical sound side loading parameters are reduced with PF_op in comparison to SACH and ESR, resulting in a relief of the sound side of lower limb amputees.
2021
Köhler, T. M.; Blumentritt, S.; Braatz, F.; Bellmann, M.
In: Gait Posture, Bd. 89, S. 169–177, 2021, ISSN: 0966-6362.
Abstract | Links | Schlagwörter: above knee amputation, adduction, adult, article, biomechanics, camera, clinical article, controlled study, female, femoral knee prosthesis, gait, Genium, ground reaction force, human, male, microprocessor, motion analysis system, pelvis, prosthetic alignment, step length, transfemoral amputation, transfemoral prosthetic socket, Triton, trunk, tyloxapol, Vicon Bonita, walking, walking speed
@article{Koehler2021,
title = {The impact of transfemoral socket adduction on pelvic and trunk stabilization during level walking - A biomechanical study},
author = {T. M. Köhler and S. Blumentritt and F. Braatz and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2013710687&from=export},
doi = {10.1016/j.gaitpost.2021.06.024},
issn = {0966-6362},
year = {2021},
date = {2021-09-01},
journal = {Gait Posture},
volume = {89},
pages = {169–177},
publisher = {Elsevier BV},
address = {T.M. Köhler, Ottobock SE & Co. KGaA, Hermann-Rein-Straße 2a, Göttingen, Germany},
abstract = {Background: It is common practice to align transfemoral prosthetic sockets in adduction, due to the physiologic, adducted femoral alignment in unimpaired legs. An adducted femoral and socket alignment helps tightening hip abductors to stabilize the pelvis and reduce pelvic and trunk related compensatory movements. Research question: How do different socket adduction conditions (SAC) of transfemoral sockets affect pelvic and trunk stabilization during level ground walking in the frontal plane? Methods: Seven persons with transfemoral amputation with medium residual limb length participated in this study. The prosthetic alignment in the sagittal plane was performed according to established recommendations. SAC varied (0°, 3°, 6°, 9°). Kinematic and kinetic parameters were recorded in a gait laboratory with a 12-camera optoelectronic system and two piezoelectric force plates embedded in a 12-m walkway. The measurements were performed during level ground walking with self-selected comfortable gait speed. Results: In the frontal plane, nearly all investigated kinematic and kinetic parameters showed a strong correlation with the SAC. The pelvis was raised on the contralateral side throughout the gait cycle with increasing SAC. During the prosthetic side stance phase, the mean shoulder obliquity and mean lateral trunk lean to the prosthetic side tended to be reduced with increased SAC. Prosthetic side hip abduction moment decreased with increasing SAC. Significance: The results confirm that transfemoral SAC contributes to pelvic stabilization and reduced compensatory movements of the pelvis and trunk. Transfemoral SAC of 6 ± 1° for bench alignment seems adequate for amputees with medium residual limb length. However, the optimum value for the individual patient may differ slightly.},
keywords = {above knee amputation, adduction, adult, article, biomechanics, camera, clinical article, controlled study, female, femoral knee prosthesis, gait, Genium, ground reaction force, human, male, microprocessor, motion analysis system, pelvis, prosthetic alignment, step length, transfemoral amputation, transfemoral prosthetic socket, Triton, trunk, tyloxapol, Vicon Bonita, walking, walking speed},
pubstate = {published},
tppubtype = {article}
}
Background: It is common practice to align transfemoral prosthetic sockets in adduction, due to the physiologic, adducted femoral alignment in unimpaired legs. An adducted femoral and socket alignment helps tightening hip abductors to stabilize the pelvis and reduce pelvic and trunk related compensatory movements. Research question: How do different socket adduction conditions (SAC) of transfemoral sockets affect pelvic and trunk stabilization during level ground walking in the frontal plane? Methods: Seven persons with transfemoral amputation with medium residual limb length participated in this study. The prosthetic alignment in the sagittal plane was performed according to established recommendations. SAC varied (0°, 3°, 6°, 9°). Kinematic and kinetic parameters were recorded in a gait laboratory with a 12-camera optoelectronic system and two piezoelectric force plates embedded in a 12-m walkway. The measurements were performed during level ground walking with self-selected comfortable gait speed. Results: In the frontal plane, nearly all investigated kinematic and kinetic parameters showed a strong correlation with the SAC. The pelvis was raised on the contralateral side throughout the gait cycle with increasing SAC. During the prosthetic side stance phase, the mean shoulder obliquity and mean lateral trunk lean to the prosthetic side tended to be reduced with increased SAC. Prosthetic side hip abduction moment decreased with increasing SAC. Significance: The results confirm that transfemoral SAC contributes to pelvic stabilization and reduced compensatory movements of the pelvis and trunk. Transfemoral SAC of 6 ± 1° for bench alignment seems adequate for amputees with medium residual limb length. However, the optimum value for the individual patient may differ slightly.
Yazdani, M.; Hajiaghaei, B.; Saeedi, H.; Kamali, M.; Yousefi, M.
In: Curr. Orthop. Pract., Bd. 32, Nr. 5, S. 505–511, 2021, ISSN: 1940-7041.
Abstract | Links | Schlagwörter: adult, amputee, article, camera, case study, clinical article, comparative study, compression release stabilization, data analysis software, evaluation study, female, femoral shaft, foot prosthesis, gait, gluteus muscle, human, information processing device, IRCT20181021041400N1, ischial tuberosity, kinematics, knee prosthesis, leather belt wrap, limb amputation, male, MATLAB, medical device, middle aged, motion analysis system, orthopedic cast, orthopedic surgical equipment, Ottobock 3R20, pilot study, prosthesis design, quadrilateral socket, solid ankle cushioned heel foot, statistical model, step length, step time, step width, stride length, stride time, symmetry index, transfemoral socket, walking, walking speed, weight training, Wilcoxon signed ranks test
@article{Yazdani2021,
title = {Does the socket design affect symmetry and spatiotemporal gait parameters? A case series of two transfemoral amputees},
author = {M. Yazdani and B. Hajiaghaei and H. Saeedi and M. Kamali and M. Yousefi},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L635549609&from=export},
doi = {10.1097/bco.0000000000001022},
issn = {1940-7041},
year = {2021},
date = {2021-01-01},
journal = {Curr. Orthop. Pract.},
volume = {32},
number = {5},
pages = {505–511},
address = {B. Hajiaghaei, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Nezam Ave, Tehran, Iran},
abstract = {Background: Socket design is thought to improve gait performance and symmetry as the other components of the prosthesis do. This study focused on the comparison of two different sockets in transfemoral amputee patients to evaluate the influence of the socket designs on gait symmetry and various spatiotemporal gait parameters. Methods: Two transfemoral amputees participated in this case series study. They were asked to walk with the quadrilateral and the new modified sockets along a 10-meter walkway. The marker-based motion capture system recorded the spatiotemporal gait data during all walking trials. Kinematic data were compared between the two test conditions using the Wilcoxon signed-rank test and Symmetry Index. Results: The new socket increased velocity and cadence and reduced step width in both amputees, compared with the quadrilateral sockets. However, a good symmetry was observed in step length, stride length, step time, and stride time within two limbs by both sockets (SI ≤10). Conclusions: The design of sockets in this study had no observed effect on gait symmetry; however, the new socket increased velocity and cadence and reduced width step in both patients compared with the quadrilateral socket. Level of Evidence: Level IV.},
keywords = {adult, amputee, article, camera, case study, clinical article, comparative study, compression release stabilization, data analysis software, evaluation study, female, femoral shaft, foot prosthesis, gait, gluteus muscle, human, information processing device, IRCT20181021041400N1, ischial tuberosity, kinematics, knee prosthesis, leather belt wrap, limb amputation, male, MATLAB, medical device, middle aged, motion analysis system, orthopedic cast, orthopedic surgical equipment, Ottobock 3R20, pilot study, prosthesis design, quadrilateral socket, solid ankle cushioned heel foot, statistical model, step length, step time, step width, stride length, stride time, symmetry index, transfemoral socket, walking, walking speed, weight training, Wilcoxon signed ranks test},
pubstate = {published},
tppubtype = {article}
}
Background: Socket design is thought to improve gait performance and symmetry as the other components of the prosthesis do. This study focused on the comparison of two different sockets in transfemoral amputee patients to evaluate the influence of the socket designs on gait symmetry and various spatiotemporal gait parameters. Methods: Two transfemoral amputees participated in this case series study. They were asked to walk with the quadrilateral and the new modified sockets along a 10-meter walkway. The marker-based motion capture system recorded the spatiotemporal gait data during all walking trials. Kinematic data were compared between the two test conditions using the Wilcoxon signed-rank test and Symmetry Index. Results: The new socket increased velocity and cadence and reduced step width in both amputees, compared with the quadrilateral sockets. However, a good symmetry was observed in step length, stride length, step time, and stride time within two limbs by both sockets (SI ≤10). Conclusions: The design of sockets in this study had no observed effect on gait symmetry; however, the new socket increased velocity and cadence and reduced width step in both patients compared with the quadrilateral socket. Level of Evidence: Level IV.
2017
Shimizu, Y.; Mutsuzaki, H.; Maezawa, T.; Idei, Y.; Takao, K.; Takeuchi, R.; Onishi, S.; Hada, Y.; Yamazaki, M.; Wadano, Y.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 5, S. 522–526, 2017, ISSN: 0309-3646.
Abstract | Links | Schlagwörter: adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing
@article{Shimizu2017,
title = {Hip prosthesis in sitting posture for bilateral transfemoral amputee after burn injury: a case report},
author = {Y. Shimizu and H. Mutsuzaki and T. Maezawa and Y. Idei and K. Takao and R. Takeuchi and S. Onishi and Y. Hada and M. Yamazaki and Y. Wadano},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L618507994&from=export},
doi = {10.1177/0309364616682384},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {5},
pages = {522–526},
address = {Y. Shimizu, Department of Rehabilitation Medicine, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, Japan},
abstract = {Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.},
keywords = {adult, amputee, article, bilateral transfemoral amputee, burn, case report, clinical article, diabetes mellitus, dipeptidyl peptidase IV inhibitor, hemoglobin A1c, hip prosthesis, human, laminoplasty, leg amputation, male, middle aged, muscle strength, Ottobock, postoperative care, range of motion, sitting, skin transplantation, swan, SwanS, walking, wheelchair, wound healing},
pubstate = {published},
tppubtype = {article}
}
Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.
2022
Ernst, M.; Altenburg, B.; Schmalz, T.; Kannenberg, A.; Bellmann, M.
Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes Artikel
In: J. NeuroEng. Rehabil., Bd. 19, Nr. 1, 2022, ISSN: 1743-0003.
@article{Ernst2022,
title = {Benefits of a microprocessor-controlled prosthetic foot for ascending and descending slopes},
author = {M. Ernst and B. Altenburg and T. Schmalz and A. Kannenberg and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2014862458&from=export},
doi = {10.1186/s12984-022-00983-y},
issn = {1743-0003},
year = {2022},
date = {2022-01-01},
journal = {J. NeuroEng. Rehabil.},
volume = {19},
number = {1},
address = {M. Ernst, Research Biomechanics, CR&S, Ottobock SE & Co. KGaA, Göttingen, Germany},
abstract = {Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Prosthetic feet are prescribed for persons with a lower-limb amputation to restore lost mobility. However, due to limited adaptability of their ankles and springs, situations like walking on slopes or uneven ground remain challenging. This study investigated to what extent a microprocessor-controlled prosthetic foot (MPF) facilitates walking on slopes. Methods: Seven persons each with a unilateral transtibial amputation (TTA) and unilateral transfemoral amputation (TFA) as well as ten able-bodied subjects participated. Participants were studied while using a MPF and their prescribed standard feet with fixed ankle attachments. The study investigated ascending and descending a 10° slope. Kinematic and kinetic data were recorded with a motion capture system. Biomechanical parameters, in particular leg joint angles, shank orientation and external joint moments of the prosthetics side were calculated. Results: Prosthetic feet- and subject group-dependent joint angle and moment characteristics were observed for both situations. The MPF showed a larger and situation-dependent ankle range of motion compared to the standard feet. Furthermore, it remained in a dorsiflexed position during swing. While ascending, the MPF adapted the dorsiflexion moment and reduced the knee extension moment. At vertical shank orientation, it reduced the knee extension moment by 26% for TFA and 49% for TTA compared to the standard feet. For descending, differences between feet in the biomechanical knee characteristics were found for the TTA group, but not for the TFA group. At the vertical shank angle during slope descent, TTA demonstrated a behavior of the ankle moment similar to able-bodied controls when using the MPF. Conclusions: The studied MPF facilitated walking on slopes by adapting instantaneously to inclinations and, thus, easing the forward rotation of the leg over the prosthetic foot compared to standard feet with a fixed ankle attachment with amputation-level dependent effect sizes. It assumed a dorsiflexed ankle angle during swing, enabled a larger ankle range of motion and reduced the moments acting on the residual knee of TTA compared to the prescribed prosthetic standard feet. For individuals with TFA, the prosthetic knee joint seems to play a more crucial role for walking on ramps than the foot.
Pröbsting, E.; Altenburg, B.; Bellmann, M.; Krug, K.; Schmalz, T.
In: Prosthet. Orthot. Int., Bd. 46, Nr. 4, S. 306–313, 2022, ISSN: 0309-3646.
@article{Proebsting2022,
title = {How does ankle power on the prosthetic side influence loading parameters on the sound side during level walking of persons with transfemoral amputation?},
author = {E. Pröbsting and B. Altenburg and M. Bellmann and K. Krug and T. Schmalz},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2019708323&from=export},
doi = {10.1097/pxr.0000000000000099},
issn = {0309-3646},
year = {2022},
date = {2022-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {46},
number = {4},
pages = {306–313},
address = {E. Pröbsting, Ottobock SE & Co. KGaA, Herrmann-Rein-Straße 2a, Göttingen, Germany},
abstract = {Background:Increased ankle power on the prosthetic side seems to decrease biomechanical loading parameters on the sound side. This assumption is based on biomechanical comparisons of different foot constructions. However, such study designs could not show whether the amount of ankle power solely influences the sound side.Objective:To analyze the influence of divergent ankle power, resulting from different foot constructions and from different ankle power settings, on the sound side loading parameters.Study design:Interventional cross sectional study.Methods:Level walking of transfemoral amputees with a microprocessor knee joint and Solid Ankle Cushioned Heel (SACH), energy storing and returning (ESR) and powered foot (PF) was analyzed. The PF was adapted in three configurations: without power (np), low power (lp), and optimal power (op). An optoelectronic camera system with 12 cameras and two force plates were used.Results:The ankle power on the prosthetic side shows significant differences about foot types and different settings of the PF. The knee adduction moment, the knee flexion moment, and the vertical ground reaction forces on the sound side were significantly reduced with PF_op and ESR in comparison to SACH. When analyzing these parameters for the different PF configurations, only some show significant results at normal velocity.Conclusions:The additional positive mechanical work for an active push off in the PF tends to have a relieving effect. The biomechanical sound side loading parameters are reduced with PF_op in comparison to SACH and ESR, resulting in a relief of the sound side of lower limb amputees.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background:Increased ankle power on the prosthetic side seems to decrease biomechanical loading parameters on the sound side. This assumption is based on biomechanical comparisons of different foot constructions. However, such study designs could not show whether the amount of ankle power solely influences the sound side.Objective:To analyze the influence of divergent ankle power, resulting from different foot constructions and from different ankle power settings, on the sound side loading parameters.Study design:Interventional cross sectional study.Methods:Level walking of transfemoral amputees with a microprocessor knee joint and Solid Ankle Cushioned Heel (SACH), energy storing and returning (ESR) and powered foot (PF) was analyzed. The PF was adapted in three configurations: without power (np), low power (lp), and optimal power (op). An optoelectronic camera system with 12 cameras and two force plates were used.Results:The ankle power on the prosthetic side shows significant differences about foot types and different settings of the PF. The knee adduction moment, the knee flexion moment, and the vertical ground reaction forces on the sound side were significantly reduced with PF_op and ESR in comparison to SACH. When analyzing these parameters for the different PF configurations, only some show significant results at normal velocity.Conclusions:The additional positive mechanical work for an active push off in the PF tends to have a relieving effect. The biomechanical sound side loading parameters are reduced with PF_op in comparison to SACH and ESR, resulting in a relief of the sound side of lower limb amputees.
2021
Köhler, T. M.; Blumentritt, S.; Braatz, F.; Bellmann, M.
In: Gait Posture, Bd. 89, S. 169–177, 2021, ISSN: 0966-6362.
@article{Koehler2021,
title = {The impact of transfemoral socket adduction on pelvic and trunk stabilization during level walking - A biomechanical study},
author = {T. M. Köhler and S. Blumentritt and F. Braatz and M. Bellmann},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L2013710687&from=export},
doi = {10.1016/j.gaitpost.2021.06.024},
issn = {0966-6362},
year = {2021},
date = {2021-09-01},
journal = {Gait Posture},
volume = {89},
pages = {169–177},
publisher = {Elsevier BV},
address = {T.M. Köhler, Ottobock SE & Co. KGaA, Hermann-Rein-Straße 2a, Göttingen, Germany},
abstract = {Background: It is common practice to align transfemoral prosthetic sockets in adduction, due to the physiologic, adducted femoral alignment in unimpaired legs. An adducted femoral and socket alignment helps tightening hip abductors to stabilize the pelvis and reduce pelvic and trunk related compensatory movements. Research question: How do different socket adduction conditions (SAC) of transfemoral sockets affect pelvic and trunk stabilization during level ground walking in the frontal plane? Methods: Seven persons with transfemoral amputation with medium residual limb length participated in this study. The prosthetic alignment in the sagittal plane was performed according to established recommendations. SAC varied (0°, 3°, 6°, 9°). Kinematic and kinetic parameters were recorded in a gait laboratory with a 12-camera optoelectronic system and two piezoelectric force plates embedded in a 12-m walkway. The measurements were performed during level ground walking with self-selected comfortable gait speed. Results: In the frontal plane, nearly all investigated kinematic and kinetic parameters showed a strong correlation with the SAC. The pelvis was raised on the contralateral side throughout the gait cycle with increasing SAC. During the prosthetic side stance phase, the mean shoulder obliquity and mean lateral trunk lean to the prosthetic side tended to be reduced with increased SAC. Prosthetic side hip abduction moment decreased with increasing SAC. Significance: The results confirm that transfemoral SAC contributes to pelvic stabilization and reduced compensatory movements of the pelvis and trunk. Transfemoral SAC of 6 ± 1° for bench alignment seems adequate for amputees with medium residual limb length. However, the optimum value for the individual patient may differ slightly.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: It is common practice to align transfemoral prosthetic sockets in adduction, due to the physiologic, adducted femoral alignment in unimpaired legs. An adducted femoral and socket alignment helps tightening hip abductors to stabilize the pelvis and reduce pelvic and trunk related compensatory movements. Research question: How do different socket adduction conditions (SAC) of transfemoral sockets affect pelvic and trunk stabilization during level ground walking in the frontal plane? Methods: Seven persons with transfemoral amputation with medium residual limb length participated in this study. The prosthetic alignment in the sagittal plane was performed according to established recommendations. SAC varied (0°, 3°, 6°, 9°). Kinematic and kinetic parameters were recorded in a gait laboratory with a 12-camera optoelectronic system and two piezoelectric force plates embedded in a 12-m walkway. The measurements were performed during level ground walking with self-selected comfortable gait speed. Results: In the frontal plane, nearly all investigated kinematic and kinetic parameters showed a strong correlation with the SAC. The pelvis was raised on the contralateral side throughout the gait cycle with increasing SAC. During the prosthetic side stance phase, the mean shoulder obliquity and mean lateral trunk lean to the prosthetic side tended to be reduced with increased SAC. Prosthetic side hip abduction moment decreased with increasing SAC. Significance: The results confirm that transfemoral SAC contributes to pelvic stabilization and reduced compensatory movements of the pelvis and trunk. Transfemoral SAC of 6 ± 1° for bench alignment seems adequate for amputees with medium residual limb length. However, the optimum value for the individual patient may differ slightly.
Yazdani, M.; Hajiaghaei, B.; Saeedi, H.; Kamali, M.; Yousefi, M.
In: Curr. Orthop. Pract., Bd. 32, Nr. 5, S. 505–511, 2021, ISSN: 1940-7041.
@article{Yazdani2021,
title = {Does the socket design affect symmetry and spatiotemporal gait parameters? A case series of two transfemoral amputees},
author = {M. Yazdani and B. Hajiaghaei and H. Saeedi and M. Kamali and M. Yousefi},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L635549609&from=export},
doi = {10.1097/bco.0000000000001022},
issn = {1940-7041},
year = {2021},
date = {2021-01-01},
journal = {Curr. Orthop. Pract.},
volume = {32},
number = {5},
pages = {505–511},
address = {B. Hajiaghaei, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Nezam Ave, Tehran, Iran},
abstract = {Background: Socket design is thought to improve gait performance and symmetry as the other components of the prosthesis do. This study focused on the comparison of two different sockets in transfemoral amputee patients to evaluate the influence of the socket designs on gait symmetry and various spatiotemporal gait parameters. Methods: Two transfemoral amputees participated in this case series study. They were asked to walk with the quadrilateral and the new modified sockets along a 10-meter walkway. The marker-based motion capture system recorded the spatiotemporal gait data during all walking trials. Kinematic data were compared between the two test conditions using the Wilcoxon signed-rank test and Symmetry Index. Results: The new socket increased velocity and cadence and reduced step width in both amputees, compared with the quadrilateral sockets. However, a good symmetry was observed in step length, stride length, step time, and stride time within two limbs by both sockets (SI ≤10). Conclusions: The design of sockets in this study had no observed effect on gait symmetry; however, the new socket increased velocity and cadence and reduced width step in both patients compared with the quadrilateral socket. Level of Evidence: Level IV.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Socket design is thought to improve gait performance and symmetry as the other components of the prosthesis do. This study focused on the comparison of two different sockets in transfemoral amputee patients to evaluate the influence of the socket designs on gait symmetry and various spatiotemporal gait parameters. Methods: Two transfemoral amputees participated in this case series study. They were asked to walk with the quadrilateral and the new modified sockets along a 10-meter walkway. The marker-based motion capture system recorded the spatiotemporal gait data during all walking trials. Kinematic data were compared between the two test conditions using the Wilcoxon signed-rank test and Symmetry Index. Results: The new socket increased velocity and cadence and reduced step width in both amputees, compared with the quadrilateral sockets. However, a good symmetry was observed in step length, stride length, step time, and stride time within two limbs by both sockets (SI ≤10). Conclusions: The design of sockets in this study had no observed effect on gait symmetry; however, the new socket increased velocity and cadence and reduced width step in both patients compared with the quadrilateral socket. Level of Evidence: Level IV.
2017
Shimizu, Y.; Mutsuzaki, H.; Maezawa, T.; Idei, Y.; Takao, K.; Takeuchi, R.; Onishi, S.; Hada, Y.; Yamazaki, M.; Wadano, Y.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 5, S. 522–526, 2017, ISSN: 0309-3646.
@article{Shimizu2017,
title = {Hip prosthesis in sitting posture for bilateral transfemoral amputee after burn injury: a case report},
author = {Y. Shimizu and H. Mutsuzaki and T. Maezawa and Y. Idei and K. Takao and R. Takeuchi and S. Onishi and Y. Hada and M. Yamazaki and Y. Wadano},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L618507994&from=export},
doi = {10.1177/0309364616682384},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {5},
pages = {522–526},
address = {Y. Shimizu, Department of Rehabilitation Medicine, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, Japan},
abstract = {Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel “hip prosthesis in the sitting posture.” Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient’s refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. Discussion and Conclusion: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance: Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.
Pröbsting, E.; Kannenberg, A.; Zacharias, B.
In: Prosthet. Orthot. Int., Bd. 41, Nr. 1, S. 65–77, 2017, ISSN: 0309-3646.
@article{Proebsting2017,
title = {Safety and walking ability of KAFO users with the C-Brace® Orthotronic Mobility System, a new microprocessor stance and swing control orthosis},
author = {E. Pröbsting and A. Kannenberg and B. Zacharias},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L614321344&from=export},
doi = {10.1177/0309364616637954},
issn = {0309-3646},
year = {2017},
date = {2017-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {41},
number = {1},
pages = {65–77},
address = {E. Pröbsting, Otto Bock HealthCare GmbH, Department Clinical Research and Services, Goettingen, Germany},
abstract = {Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Methods: Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. Results: The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation (p =.001), paretic limb health (p =.04), sounds (p =.02), and well-being (p =.01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. Conclusion: The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled knee flexion during weight bearing and dynamic swing control, resulting in significant improvements in perceived orthotic mobility and safety.
2016
Hahn, A.; Lang, M.; Stuckart, C.
In: Medicine, Bd. 95, Nr. 45, 2016, ISSN: 0025-7974.
@article{Hahn2016,
title = {Analysis of clinically important factors on the performance of advanced hydraulic, microprocessor-controlled exo-prosthetic knee joints based on 899 trial fittings},
author = {A. Hahn and M. Lang and C. Stuckart},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L613375887&from=export},
doi = {10.1097/md.0000000000005386},
issn = {0025-7974},
year = {2016},
date = {2016-01-01},
journal = {Medicine},
volume = {95},
number = {45},
address = {A. Hahn, Otto Bock Healthcare Products GmbH, Brehmstrasse 16, Vienna, Austria},
abstract = {The objective of this work is to evaluate whether clinically important factors may predict an individual's capability to utilize the functional benefits provided by an advanced hydraulic, microprocessor-controlled exo-prosthetic knee component. This retrospective cross-sectional cohort analysis investigated the data of above knee amputees captured during routine trial fittings. Prosthetists rated the performance indicators showing the functional benefits of the advanced maneuvering capabilities of the device. Subjects were asked to rate their perception. Simple and multiple linear and logistic regression was applied. Data from 899 subjects with demographics typical for the population were evaluated. Ability to vary gait speed, perform toileting, and ascend stairs were identified as the most sensitive performance predictors. Prior C-Leg users showed benefits during advanced maneuvering. Variables showed plausible and meaningful effects, however, could not claim predictive power. Mobility grade showed the largest effect but also failed to be predictive. Clinical parameters such as etiology, age, mobility grade, and others analyzed here do not suffice to predict individual potential. Daily walking distance may pose a threshold value and be part of a predictive instrument. Decisions based solely on single parameters such as mobility grade rating or walking distance seem to be questionable.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The objective of this work is to evaluate whether clinically important factors may predict an individual's capability to utilize the functional benefits provided by an advanced hydraulic, microprocessor-controlled exo-prosthetic knee component. This retrospective cross-sectional cohort analysis investigated the data of above knee amputees captured during routine trial fittings. Prosthetists rated the performance indicators showing the functional benefits of the advanced maneuvering capabilities of the device. Subjects were asked to rate their perception. Simple and multiple linear and logistic regression was applied. Data from 899 subjects with demographics typical for the population were evaluated. Ability to vary gait speed, perform toileting, and ascend stairs were identified as the most sensitive performance predictors. Prior C-Leg users showed benefits during advanced maneuvering. Variables showed plausible and meaningful effects, however, could not claim predictive power. Mobility grade showed the largest effect but also failed to be predictive. Clinical parameters such as etiology, age, mobility grade, and others analyzed here do not suffice to predict individual potential. Daily walking distance may pose a threshold value and be part of a predictive instrument. Decisions based solely on single parameters such as mobility grade rating or walking distance seem to be questionable.
2014
Whitehead, J. M. Aldridge; Wolf, E. J.; Scoville, C. R.; Wilken, J. M.
In: Clin. Orthop. Relat. Res., Bd. 472, Nr. 10, S. 3093–3101, 2014, ISSN: 0009-921X.
@article{AldridgeWhitehead2014,
title = {Does a Microprocessor-controlled Prosthetic Knee Affect Stair Ascent Strategies in Persons With Transfemoral Amputation?},
author = {J. M. Aldridge Whitehead and E. J. Wolf and C. R. Scoville and J. M. Wilken},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L608263443&from=export},
doi = {10.1007/s11999-014-3484-2},
issn = {0009-921X},
year = {2014},
date = {2014-10-01},
journal = {Clin. Orthop. Relat. Res.},
volume = {472},
number = {10},
pages = {3093–3101},
publisher = {Ovid Technologies (Wolters Kluwer Health)},
address = {J.M. Wilken, DOD-VA Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, 3551 Roger Brooke Drive, Ft Sam Houston, TX, United States},
abstract = {Background: Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2®) uses flexion/extension resistance to allow step-over-step stair ascent. Questions/Purposes: We compared self-selected stair ascent strategies between conventional and X2® prosthetic knees, examined between-limb differences, and differentiated stair ascent mechanics between X2® users and individuals without amputation. We also determined which factors are associated with differences in knee position during initial contact and swing within X2® users. Methods: Fourteen individuals with transfemoral amputation participated in stair ascent sessions while using conventional and X2® knees. Ten individuals without amputation also completed a stair ascent session. Lower-extremity stair ascent joint angles, moment, and powers and ground reaction forces were calculated using inverse dynamics during self-selected strategy and cadence and controlled cadence using a step-over-step strategy. Results: One individual with amputation self-selected a step-over-step strategy while using a conventional knee, while 10 individuals self-selected a step-over-step strategy while using X2® knees. Individuals with amputation used greater prosthetic knee flexion during initial contact (32.5°},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2®) uses flexion/extension resistance to allow step-over-step stair ascent. Questions/Purposes: We compared self-selected stair ascent strategies between conventional and X2® prosthetic knees, examined between-limb differences, and differentiated stair ascent mechanics between X2® users and individuals without amputation. We also determined which factors are associated with differences in knee position during initial contact and swing within X2® users. Methods: Fourteen individuals with transfemoral amputation participated in stair ascent sessions while using conventional and X2® knees. Ten individuals without amputation also completed a stair ascent session. Lower-extremity stair ascent joint angles, moment, and powers and ground reaction forces were calculated using inverse dynamics during self-selected strategy and cadence and controlled cadence using a step-over-step strategy. Results: One individual with amputation self-selected a step-over-step strategy while using a conventional knee, while 10 individuals self-selected a step-over-step strategy while using X2® knees. Individuals with amputation used greater prosthetic knee flexion during initial contact (32.5°
2012
Portnoy, S.; Kristal, A.; Gefen, A.; Siev-Ner, I.
In: Gait Posture, Bd. 35, Nr. 1, S. 121–125, 2012, ISSN: 1879-2219.
@article{Portnoy2012,
title = {Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: Hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet},
author = {S. Portnoy and A. Kristal and A. Gefen and I. Siev-Ner},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L51635905&from=export},
doi = {10.1016/j.gaitpost.2011.08.021},
issn = {1879-2219},
year = {2012},
date = {2012-01-01},
journal = {Gait Posture},
volume = {35},
number = {1},
pages = {121–125},
address = {S. Portnoy, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel},
abstract = {The prosthetic foot plays an important role in propelling, breaking, balancing and supporting body loads while the amputee ambulates on different grounds. It is therefore important to quantify the effect of the prosthetic foot mechanism on biomechanical parameters, in order to prevent pressure ulcers and deep tissue injury. Our aim was to monitor the internal stresses in the residuum of transtibial amputation (TTA) prosthetic-users ambulating on different terrains, which the amputees encounter during their daily activities, i.e. paved floor, grass, ascending and descending stairs and slope. We specifically aimed to compare between the internal stresses in the TTA residuum of amputees ambulating with a novel hydraulic prosthetic foot compared to conventional energy storage and return (ESR) prosthetic feet. Monitoring of internal stresses was accomplished using a portable subject-specific real-time internal stress monitor. We found significant decrease (p<. 0.01) in peak internal stresses and in the loading rate of the amputated limb, while walking with the hydraulic foot, compared to walking with ESR feet. The loading rate calculated while ambulating with the hydraulic foot was at least three times lower than the loading rate calculated while ambulating with the ESR foot. Although the average decrease in internal stresses was ∼2-fold larger when replacing single-toe ESR feet with the hydraulic foot than when replacing split-toed ESR feet with the hydraulic foot, the differences were statistically insignificant. Our findings suggest that using a hydraulic prosthetic foot may protect the distal tibial end of the TTA residuum from high stresses, therefore preventing pressure-related injury and pain. © 2011 Elsevier B.V.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The prosthetic foot plays an important role in propelling, breaking, balancing and supporting body loads while the amputee ambulates on different grounds. It is therefore important to quantify the effect of the prosthetic foot mechanism on biomechanical parameters, in order to prevent pressure ulcers and deep tissue injury. Our aim was to monitor the internal stresses in the residuum of transtibial amputation (TTA) prosthetic-users ambulating on different terrains, which the amputees encounter during their daily activities, i.e. paved floor, grass, ascending and descending stairs and slope. We specifically aimed to compare between the internal stresses in the TTA residuum of amputees ambulating with a novel hydraulic prosthetic foot compared to conventional energy storage and return (ESR) prosthetic feet. Monitoring of internal stresses was accomplished using a portable subject-specific real-time internal stress monitor. We found significant decrease (p<. 0.01) in peak internal stresses and in the loading rate of the amputated limb, while walking with the hydraulic foot, compared to walking with ESR feet. The loading rate calculated while ambulating with the hydraulic foot was at least three times lower than the loading rate calculated while ambulating with the ESR foot. Although the average decrease in internal stresses was ∼2-fold larger when replacing single-toe ESR feet with the hydraulic foot than when replacing split-toed ESR feet with the hydraulic foot, the differences were statistically insignificant. Our findings suggest that using a hydraulic prosthetic foot may protect the distal tibial end of the TTA residuum from high stresses, therefore preventing pressure-related injury and pain. © 2011 Elsevier B.V.
2010
Ludwigs, E.; Bellmann, M.; Schmalz, T.; Blumentritt, S.
Biomechanical differences between two exoprosthetic hip joint systems during level walking Artikel
In: Prosthet. Orthot. Int., Bd. 34, Nr. 4, S. 449–460, 2010, ISSN: 1746-1553.
@article{Ludwigs2010,
title = {Biomechanical differences between two exoprosthetic hip joint systems during level walking},
author = {E. Ludwigs and M. Bellmann and T. Schmalz and S. Blumentritt},
url = {https://www.embase.com/search/results?subaction=viewrecord&id=L360015209&from=export},
doi = {10.3109/03093646.2010.499551},
issn = {1746-1553},
year = {2010},
date = {2010-01-01},
journal = {Prosthet. Orthot. Int.},
volume = {34},
number = {4},
pages = {449–460},
address = {E. Ludwigs, Research Department, Otto Bock HealthCare GmbH, Hermann-Rein-Str. 2a, Gttingen, 37075, Germany},
abstract = {Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Previous studies have shown low end-user acceptance of a hip disarticulation style prosthesis and that the limitations of such prostheses, including poor gait pattern, socket discomfort, weight of the prosthesis, loss of mobility, instability and high energy consumption are a contributing factor. This study was initiated to determine if a new style of prosthetic hip joint could help to overcome some of the limitations concerning the gait pattern. The present study analyzed the gait pattern of six hip disarticulation amputee subjects. The objective was to compare two different prosthetic hip joints, both from Otto Bock HealthCare: The new Helix3D and the 7E7, which is based on the Canadian model proposed by McLaurin (1954). Kinematics and kinetics were recorded by an optoelectronic camera system with six CCD cameras and two force plates. During weight acceptance, the Helix3D extends considerably slower and reaches full extension later than the 7E7. The increased range of pelvic tilt observed with hip disarticulation amputees is significantly reduced (by 5±3 degrees) when using the Helix3D Hip Joint. In addition, this system showed increased stance phase knee joint flexion as well as increased maximum swing phase knee flexion angles compared to the 7E7. These motion analysis results show that the Helix3D Hip Joint can reduce gait abnormalities compared to the uniplanar design of the 7E7 hip joint. © 2010 ISPO.